Food insecurity becoming a national health problem that physicians can help

Chronic hunger and its effects have become a national health problem that physicians and lawmakers must deal with, according to the American College of Physicians (ACP).

The organization has published a new position paper outlining six recommendations to tackle food insecurity that leads to nutrition insecurity, which in turn affects diet-related conditions such as diabetes, obesity, coronary artery disease, certain types of cancer and nonalcoholic steatohepatitis.

In medicine, there is a growing understanding that social drivers of health affect the health of patients. That includes food insecurity, estimated to affect about 13.8 million households with 38.3 million people across the United States in 2019 and 2020.

“Food insecurity is one social factor that has direct and indirect effects on a person's physical, cognitive, and mental health,” the paper said. “Despite its known effect on health, little sustainable progress has been made on reducing the incidence of food insecurity and improving accessible nutritional choices in the United States. Although a network of various federal, state, and community programs — both public and private — is in place to provide assistance for food-insecure individuals, food insecurity persists as a result of inadequate support levels, barriers to accessing programs, and rigid requirements that render many food-insecure individuals ineligible.”

“Strengthening Food and Nutrition Security to Promote Public Health in the United States: A Position Paper From the American College of Physicians,” was published June 28 in ACP’s Annals of Internal Medicine.

For physicians

Among the recommendations, ACP believes physicians and other medical staff must be better at understanding and mitigating food insecurity of their patients.

“Patient surveys have found that wide majorities find value in screening for food insecurity at primary care visits and believe it contributes to improved care and feelings of being better understood,” the paper said. ACP credited the two-question screening methods used by the American Academy of Pediatrics and the American Academy of Family Physicians.

Across the country, currently 30% of physician practices and 40% of hospitals screen for food insecurity. Time constraints with patients mean doctors must focus on interventions that are proven to improve health, according to ACP, and physicians taking on hunger need help.

“Given the many competing demands faced during a brief office visit, it is important that physicians are supported by payers, institutions, governments, and their communities,” the ACP paper said. That includes adequate reimbursement for practices and new reimbursement codes for screening and referral efforts.

Among its policy recommendations, ACP called for more high-quality research on the effectiveness of screening, education, and treatments, along with additional research to inform policymakers about the human costs of food and nutrition insecurity.

Nonclinical approaches

ACP noted physicians might consider nonclinical approaches, such as:

• Serving as a food distribution site
• Partnering with local food retailers, organizations and schools
• Investing in community resources and organizations
• Engaging in advocacy to inform public debate on food insecurity

Other recommendations

In the United States, federal, state, and local governments supply “the overwhelming majority of food assistance,” so the nation needs a “health-in-all-policies” approach to public policy, according to ACP. Some of the other four other policy recommendations dealt explicitly with government policies and programs:

• ACP affirms the need for all people to have adequate access to healthy food and addressing food and nutrition insecurity must become a policy and funding priorities.
• Congress and other policymakers should fund and support efforts to reduce food and nutrition insecurity, and should protect nutrition assistance programs from “appropriations failures” and conversion to block grant programs.
• The Supplemental Nutrition Assistance Program (SNAP), administered by the U.S. Department of Agriculture, is an $80 billion program that serves about 41.9 million people. It must be improved, with benefit levels increased.

In recent years, the average SNAP monthly benefits was $240 per household or $121 per person – or $1.40 per person per meal, not enough to cover actual low-income meal costs in 99% of counties in the continental United States.

The SNAP benefit was recalculated for 2022, but most households will see only a modest increase because public health emergency benefits will expire. Policymakers must set benefit levels high enough to lift people out of food insecurity, ACP said.

• The federal Centers for Medicare & Medicaid Services must develop, test and support innovated models and waivers for benefits and activities that address social drivers of health, including food insecurity.
• For the nation, connecting those hungry with food that is wasted in a year – estimated to be worth $408 billion -- could bridge the gap in a sustainable manner.